Healthcare Provider Details

I. General information

NPI: 1497893283
Provider Name (Legal Business Name): AMBER NICOL BAUGNET MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MAIN ST STE 122
GREEN BAY WI
54302-1341
US

IV. Provider business mailing address

1263 MAIN ST STE 122
GREEN BAY WI
54302-1341
US

V. Phone/Fax

Practice location:
  • Phone: 920-415-2002
  • Fax:
Mailing address:
  • Phone: 920-415-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5250-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: